Transgender HRTHow to start hormone therapy

Dr Helen Webberleywww.transgender.mywebdoctor.co.uk

Transgender Health In addition to the usual health needs that

everyone has, transgendered people also have more specific needs in relation to gender dysphoria or gender reassignment, realignment or confirmation.

The particular needs of transgendered people may be looked after by the specifically targeted health services offered through NHS gender identity clinics as well as an individual’s GP. Some people prefer to use private services rather than the NHS.

1. Contact a Doctor You can get advice on gender issues from your GP. They can refer you

to an NHS Gender Identity Clinic. Some people prefer to access private clinics to avoid long waits or because they don’t want to involve their GP.

Before you can go down the NHS gender identity clinic route you will need a referral. This is usually provided by your GP although a private doctor can also do this and sometimes a self-referral is accepted, although this is rare and will depend upon the clinic and their guidelines.

Whoever you speak to will need to know that this is the right path for you as well as ensuring that you are physically and emotionally able to cope with the treatment. Your doctor will ask some standard medical history questions but be sure to add anything extra that they don’t already know so that they can make sure the treatment is the best available for you, and the safest.

2. Give Your Consent Like with any treatment, you will be given a

consent form for hormone therapy. This will be in the form of a document provided to you which will need to be read, understood, signed and returned.

Make sure you are happy with all that it says, and ask your doctor if you have any queries. The consent form will explain everything about the treatment and what it will mean for you. Be sure you are comfortable with it before you begin treatment.

3. Undergo Counseling Part of the assessment, treatment and ongoing support of

gender therapy will include counseling / talking therapy / psychotherapy. This may be a pre-requisite of the GIC referral or it may happen as part of that process – or both.

When going privately you will need to undergo an assessment to make sure that you are ready for all of the changes that are going to happen, or to give you the tools and mechanisms to get ready. Waiting lists are long on the NHS so be prepared for a wait. Privately, an experienced counselor will have a chat with you and this may be a single session or take several sessions. They will want to make sure you understand everything and to make sure that gender therapy is right for you.

4. Health Checks As mentioned at the start, you will need to be healthy enough

to receive treatment. As part of the medical assessment blood tests and a blood pressure reading will need to be organised before the start of the treatment. These can be done by your GP, local pharmacy, or you can even use private home testing kits.

The minimum tests required are:

• Liver

• Cholesterol

• Diabetes

• Blood pressure

5. Take the Medication as Prescribed

It sounds simple but this step is crucial to your ongoing care – once you have been issued a prescription you will need to take the treatment only as prescribed. Adjusting your prescription appropriately will be impossible if you amend the amounts taken. It may feel slow but the changes will come.

You will be recommended feminization or masculinisation hormones as oestrogen or testosterone. Blockers to your natural hormones may be given as well. The oestrogen will develop the female features for you and the blockers will block testosterone to make the oestrogen work better. Testosterone will cause masculine features to develop in Transmen.

6. Watch Your Body Change

This is then the very exciting time when your body will change to match your true gender. Everyone changes at different rates and it is best to go slowly and steadily.

If you think that your changes are too fast or too slow then discuss this with your doctor.

If you notice anything that you weren’t expecting then ask your doctor.

Tips • Be honest at all points during the process.

Hiding information may cause your treatment to be stopped and may be dangerous for you.

The counselling sessions are there to help so be as open as you are able or ask for help to open up more – otherwise you may not get the outcome you are hoping for.

Warnings: • Only take the medication as prescribed. It is not an

instant fix but the results will come.

• Do not self-medicate. You will not know how reliable the source is and if the medication is as described. You will need to be properly monitored throughout treatment. If you are self-medicating, ask a fully registered doctor to swap your prescription for a real one.

• You can stop taking the hormones at any time if you feel that the effects are unhelpful or unpleasant. However, effects already seen as a result of treatment may not be fully reversed.

RisksThe most serious risks when taking oestrogens are:

* Thrombosis.

* Altered liver function.

The most serious risks when taking testosterone is:

* Polycythaemia (over production of the red blood cells).

RESOURCES https://transgender.mywebdoctor.co.uk/

http://www.nhs.uk/Livewell/Transhealth/Documents/gender-dysphoria-guide-for-gps-and-other-health-care-staff.pdf

http://patient.info/doctor/gender-dysphoria-pro

http://gendertrust.org.uk/

http://www.gires.org.uk/